CRRT treatment
The indications for CRRT in our
study were as follow: 1) hypercreatinemia or azotemia (creatinine levels
of >2 mg/dL; 2) blood urea nitrogen levels of
>40 mg/dL); 3) oliguria (urine output of <0.5
mL/kg/h); 4) fluid overload >10%; 5) acute liver failure
complicated with hepatorenal syndrome or hyperammonaemia; 6) severe
electrolyte imbalance which did not respond immediately to conventional
therapy (hyperkalaemia >7 mmol/L;
hypernatraemia>160 mmol/L or hyponatraemia<110
mmol/L).
Vascular access was obtained with 5F dual-lumen ( Arrow,
Teleflex Inc, Limerick, PA, USA), 6.5F–12F central venous catheters
(GamCath; Gambro, Colombes, France) in the right internal jugular or
femoral vein, according to patient body weight.
Two CRRT devices were used, including the Plasauto iQ21 (Asahi KASE,
Japan), and PRISMA flex (Gambro Renal Products, France).
Polyacrylonitrile AN69 or polysulfone hollow-fibre haemofilters were
used, depending on the body surface area of the patient and on the pump
employed. M10 filters (Gambro Renal Products, France) or AEF-03(Asahi
KASE, Japan) were used in children weighing less than 5 kg; M60 (Gambro
Renal Products, France) or (Asahi KASE, Japan) was used in patients
weighing between 5 and 35 kg, and M100 (Gambro Renal Products, France)
or AEF-10 (Asahi KASE, Japan) in children weighing over 35 kg.
Thirty-three patients (63.5%) received
CVVH, and nineteen patients
(36.5%) received continuous venovenous hemodiafiltration (CVVHDF) with
an ultrafiltrate flow rate of 35–50 mL/kg/hr. Hemofilters changes were
scheduled every 24h or when clotted.
The dosage of was 5-20U/kg.h to maintain activated partial
thromboplastin time (APTT) with 1.5-2 folds of normality during CRRT.
Anticoagulation was achieved with heparin adjusted to a target
activated partial thromboplastin
time (APTT) of 41.5- to 2-fold of normal value.
The regional citrate
anticoagulation (RCA) procedure was conducted according to the
guidelines from the Prismaflex operator’s manual. When sodium citrate
was used as anticoagulation, the target post-filter ionized calcium
level of 0.25–0.35 mmol/L was maintained. The citrate effect was
neutralized using a continuous calcium infusion of 10% calcium
gluconate to maintain ionized calcium blood levels between 1.0 and
1.2 mmol/L.